PANDUAN PRAKTIK KLINIS (PPK) RUMAH SAKIT LAVALETTE MALANG 2014 DEMAM TIFOID 1. Penge engert rt! !n n (De" (De"n n# #))
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3. Pe$er*#!!n F#*
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Krter! D!gn#
De$! De$!$ $ t%& t%&' ' $er $er!* !*!n !n en+ en+!* !*t t ##t ##te$ e$* * !*t !*t +!ng +!ng '# '#e,! e,!,* ,*!n !n &-e &-e *$!n *$!n Salmonella typhi atau Salmonella partatyphy De$!$ n!* #e/!r! ,ert!ngg! !'! $ngg ert!$! ert!$! -!- 'e$!$ $enet! (*&ntn+) (*&ntn+) !t! re$nten !'! $ngg *e'!. De$!$ tert!$! #&r #&re$!$!-!$ !$ !r !r #!* #!*t *e!e!-! ! n+e n+er &t&t &t&t !n&re! !n&re! $!- $nt! &,#t!# !t! '!re 1. Fe,r# 2. Ke#!'!r e#!'!r!n !n ,er ,er*!, *!,t t 3. r!' r!'*!r *!r'! '! re-!t re-!t%% (enn (enng* g*!t!n !t!n # 1 0 5 t'! t'!* * '* '*t t en enng ng* *!t!n !t!n 'en+ 'en+t t n!' n!' 6$nt) 4. L'! L'! +!ng +!ng ,er# ,er#ee-! !t t (*&t (*&t&r &r 'te 'teng ng! ! te '!n 7ng $er! #ert! tre$&r) tre$&r) 8. He! He!t& t&$e $eg! g!- - 9. S-e S-en& n&$e $eg! g!- - :. N+er N+er A, A,'& '&$e $en n 6. Re&-!e e&-!e (7!r!ng (7!r!ng !'! !'! &r!ng &r!ng In'&ne# In'&ne#!). !). D!!t 'te$*!n -e*&en -e*t# !t! -e*t n&r$!- !nen&"-! -$% -$%& &en en! ! en enng ng* *!t!n !t!n LED LED !ne$ !ne$! ! rng!n rng!n tr&$, tr&$,t&en t&en! ! g!ngg!n g!ngg!n %ng# !t. K-tr '!r! (,!*!n e$e') t% !t! !t! en enng ng*! *!t! t!n n tte tterr 7 7 <'!<'!- =4 *!- *!- -! -!tt #ete #ete-! -! #!t #!t $ng $ngg g $e$! $e$!#t #t* *!n !n '!gn& '!gn# ##.. U7 <'!<'!- tngg! tngg!-- 'eng!n 'eng!n tter tter !nt, !nt,&' &' O 132 1320 0 !t! !t! H I 94 940 0 '#e '#ert rt! ! g!$,!r!n *-n# *!# $en+&*&ng '!gn#. Hepatitis Tifosa -! $e$en 3 !t! -e, *rter! K-! (1;; (1;;0) 0)>> e! e!t& t&$e $eg! g!- - *te *ter r* * *e-! e-!n! n!n n -!,&r!t&r$ (!nt!r! -!n > ,-r,n = 309 $&-- enng*!t!n SGOTSGPT •
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enrn!n n'e*# PT) *e-!n!n #t&!t&-&g. Tifoid Karier Dte$*!nn+! *$!n Salmonella typhy '!-!$ ,!*!n %e#e# !t! rn !'! #e#e&r!ng t!n! t!n'! *-n# n%e*# !t! !'! #e#e&r!ng #ete-! 1 t!n !#/!? 'e$!$ t%&'. •
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D!gn# Ker7! De$!$ T%&' D!gn# !n'ng !. Letr# ,. M!-!r! /. S!-$&ne--# '. De$!$ Denge e. Pne$&n! 12. Pe$er*#!!n !. D!r! er%er -eng*! te# %ng# !t Penn7!ng #er&-&g *-tr '!r! (,!*!n e$e') 13.
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Nonfarmakologis : Tr! ,!rng $!*!n!n -n!* ren'! #er!t Farmakologis : S$t&$!t# Ant$*r&,!> – P-!n t!$! > K-&r!$%en*&- 4 800 $g #!$! 'eng!n : !r ,e,!# 'e$!$. A-tern!t% -!n > – T!$%en*&- 4 800 $g (*&$-*!# e$!t&-&g -e, ren'! ',!n'ng*!n *-&r!$%en*&-) – K&tr$&*#!@&- 2 ;90$g #e-!$! 2 $ngg – A$#-n '!n !$&*##-n 80?180 $g*g #e-!$! 2 $ngg – Se%!-&rn gener!# III +!ng ter,*t e%e*t% !'!-! #e%tr!*#&n 3?4 gr!$ '!-!$ 'e*#tr! 100 // #e-!$! B 7!$ er? n%# #e*!- #e!r #e-!$! 3?8 !r. D!!t -! ',er*!n #e%&t!*#$ 2?3 1 gr!$ #e%&er!@&n 21 gr!$ F-&r&*n&-&n ('e$!$ $$n+! -## !'! !r III !t! $en7e-!ng !r IV)> – N&rC&*#!#n 2 400 $g!r #e-!$! 14 !r – Sr&C&*#!#n 2 800 $g!r #e-!$! 9 !r • •
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– OC&*#!#n 2 400 $g!r #e-!$! : !r – PeC&*#!#n 1 400 $g!r #e-!$! : !r – F-er&*#!#n 1 400 $g!r #e-!$! : !r P!'! *!## t&*## t%&' ('e$!$ t%&' '#ert! g!ngg!n *e#!'!r!n 'eng!n !t! t!n! *e-!n!n ner&-&g# -!nn+! '!n !#- e$er*#!!n /!r!n &t!* $!# '!-!$ ,!t!# n&r$!-) -!ng#ng ',er*!n *&$,n!# *-&r!$%en*&- 4 800 $g 'eng!n !$#-n 41 gr!$ '!n 'e*#!$et!#&n 3 8 $g. K&$,n!# !nt,&t*! !n+! 'n'*!#*!n !'! t&*## t%&' ert&nt# !t! er%&r!# ren7!t!n #et*. Ster&' !n+! 'n'*!#*!n !'! t&*## t%&' !t! 'e$!$ t%&' +!ng $eng!-!$ ren7!t!n #et* 'eng!n '# 3 8 $g Kasus Tifod Karier> T!n! *&-e-t!## -!n reg$en ter! #e-!$! 3 ,-!n > 100 $g*g!r – A$#-n Pr&,ene#' 30 $g*g!r – A$&*##-n 100 $g*g!r Pr&,ene#' 30 $g*g!r – K&tr$&*#!@&- 2 2 t!,-et!r Deng!n K&-e-t!## *&-e##te*t&$ reg$en ter#e,t ' !t!# #e-!$! 26 !r !t! *&-e*##te*t&$ #!-! #!t re7$en ,er*t > – Sr&C&*#!#n 2 :80 $g!r – N&rC&*#!#n 2 400 $g!r Deng!n n%e*# Schistosoma haematobium pada traktus urinarius er!'*!# Shictosoma haematobium > – Pr!@*!nte- 40 $g*g '# tngg!- !t! – Metr%&n!t :8?10 $g*g ,-! er- ',er*!n 3 '# nter!- 2 $ngg Sete-! er!'*!# ,er!#- ',er*!n •
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re7$en ter! nt* t%&' *!rer #eert ' !t!# Perhatian> P!'! *e!$-!n> F-&r&*n&-&n '!n *&tr$&*#!@&- t'!* ,&-e 'gn!*!n K-&r!$%en*&- t'!* '!n7r*!n !'! tr$e#ter III. T!$%en*&- t'!* '!n7r*!n !'! tr$e#ter I. O,!t +!ng '!n7r*!n g&-&ng!n ,et! -!*t!$> !$#-n !$&*##-n '!n #e%!-&rn gener!# III (Se%tr!*#&n) •
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Inte#tn!> er'!r!!n nte#tn!- er%&r!# ## -e# !r!-t* !n*re!tt#. Etr!?nte#tn!> *!r'&!#*-!r (*eg!g!-!n #r*-!# er%er $&*!r't# tr&$,# tr&$,&Ce,t# e$!t&-&g* (!ne$! e$&-t* tr&$,t&en! KID) !r (ne$&n! e$e$! -ert# e!t&,-er (e!tt# *&-e##tt#) gn7!(g-e$er-&ne%rt# e-&ne%rt# erne%rt#) t-!ng (te&$e-t# ertt# #&n'-t# !rtrt#) ner&#*!tr* (t&*## t%&')
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Men/eg! ter7!'n+! 'e$!$ t%&' 'eng!n *e!#!'!!n ter!'! 7!-r en+e,!r!n *$!n $e-!- $!*!n!n '!n !r #!nt!# ,. Pen''*!n *e#e!t!n /. Preent% '!n *&ntr&- en-!r!n 19. Pr&gn# A' t!$ > ',! !' ,&n!$ A' #!n!t&n!$ > ',! !' ,&n!$ A' %$g#&n!$ > ',! !' ,&n!$ 1:. Tng*!t E'en# IV 16. Tng*!t 5 Re*&$en'!# 1;. Pene-!! Krt# !. Dr. G!t&et I#$!n&e SPD?KPTI ,. Dr. Nn* '!rt SPD?KPTI /. Dr. D' 5!n'r!'*#$! SPD
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